Papers by Sozos Fasouliotis
CLINICAL ASSISTED REPRODUCTION Evaluation and Treatment of Low Responders in Assisted Reproductive Technology: A Challenge to Meet
J Assist Reprod Genet, 2000
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2002
The introduction of high-resolution ultrasonography combined with color-coded Doppler imaging off... more The introduction of high-resolution ultrasonography combined with color-coded Doppler imaging offered a breakthrough in the evaluation of the human fetal venous system, considerably enhancing our understanding of fetal venous circulation in normal physiologic conditions, as well as providing us the ability to study circulatory changes in abnormal circumstances. The purpose of this study was to describe the normal anatomic development and complex of anomalies of the human fetal venous system and to review recently published series of these anomalies. Normal embryologic and anatomic development is described. An English language literature search of recent MEDLINE listings was performed to glean data from recently published series reporting prenatal diagnosis of the various anomalies and their associated malformations. Anomalies of the human fetal venous system occur sporadically, often associated with cardiac or other malformations. The pathophysiologic mechanisms leading to abnormal ...
Placenta accreta--summary of 10 years: a survey of 310 cases
Placenta
The objective was to study the incidence, risk factors, and outcome of pregnancies complicated by... more The objective was to study the incidence, risk factors, and outcome of pregnancies complicated by placenta accreta in our population. Retrospective analysis of all deliveries between the years 1990-2000, and identification of all cases of placenta accreta, defined by clinical or histological criteria. For comparison purposes we defined two sub-groups: (i) all cases that ended with severe outcome and (ii) all patients who had a previous event of placenta accreta in one or more of their previous deliveries. We evaluated the potential risk factors leading to these conditions. The SPSS software package was used for statistical analysis. Univariate and multivariate analyses were performed by stepwise logistic regression. The study covered 34 450 deliveries from which 310 cases of placenta accreta were diagnosed (0.9 per cent). The risk factors associated with placenta accreta were previous cesarean delivery (12 per cent), advanced maternal age, high gravidity, multiparity, previous curet...
Evaluation and treatment of low responders in assisted reproductive technology: a challenge to meet
Journal of assisted reproduction and genetics, 2000
To investigate the various methods of evaluation and treatment of patients with a low response to... more To investigate the various methods of evaluation and treatment of patients with a low response to controlled ovarian hyperstimulation in assisted reproductive technologies (ART). Review and analysis of relevant studies published in the last decade, identified through the literature and Medline searches. While a universally accepted definition for low responders is still lacking, these patients are reported to represent about 10% of the ART population. Several ovarian reserve screening techniques have been proposed; however, currently the best-characterized and most sensitive screening tools available are the basal day 3 serum follicle-stimulating hormone level and the clomiphene citrate challenge test. When abnormal, these tests allow physicians to counsel patients that their prognosis for conception is poor. Although the presence of a normal result does indicate better long-term chances for conception, on age-related decline in fecundity remains and patient age should still be cons...
General Concepts of Endocrine Manipulation of Assisted Reproduction
Diagnosis and Management of Ovarian Disorders, 2004
O-62. PGD: the Hadassah experience
Reproductive BioMedicine Online, 2002
Ultrasonographic prenatal diagnosis of microcephalic osteodysplastic primordial dwarfism types I/III
Prenatal Diagnosis, 2000
Microcephalic osteodysplastic primordial dwarfism is a rare disease characterized by unique clini... more Microcephalic osteodysplastic primordial dwarfism is a rare disease characterized by unique clinical appearance and specific radiographic findings, and distinctive brain abnormalities. We describe the prenatal diagnosis of two siblings with microcephalic osteodysplastic primordial dwarfism types I/III at 23 and 26 weeks of gestation, respectively. Early detection by sequential antenatal sonographic evaluation is important for counselling families known to be at risk of this rare disease.
The role of inflammatory cytokines in Meigs? syndrome
Obstetrics & Gynecology, 2002
Inflammatory cytokines are known to induce capillary leakage and third-space fluid accumulation i... more Inflammatory cytokines are known to induce capillary leakage and third-space fluid accumulation in numerous gynecologic and nongynecologic disorders. This study aimed to assess their role in Meigs' syndrome. Evaluation of serum, peritoneal, and pleural fluids retrieved from a patient suffering from Meigs' syndrome revealed high interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha levels. After surgical removal of the ovarian tumor and with resolution of ascites and hydrothorax, serum levels of IL-1beta, IL-6, and IL-8 declined, whereas tumor necrosis factor-alpha levels remained high. The correlation between these inflammatory cytokines and the clinical course of Meigs' syndrome suggests their involvement in the formation of ascites and hydrothorax in this disorder.
BRCA1 and BRCA2 Gene Mutations: Decision-Making Dilemmas Concerning Testing and Management
Obstetrical & Gynecological Survey, 2000
The identification of the BRCA genes, and their possible etiologic relationship with various form... more The identification of the BRCA genes, and their possible etiologic relationship with various forms of inherited cancer, has been recognized universally as a cornerstone in the search of cancer's genetic susceptibility. Female BRCA gene mutation carriers are found to carry an increased risk of developing breast or ovarian cancer and to a lesser degree, colon cancer, and male BRCA mutation carriers are also related to an increased risk of breast, colon, or prostate cancer. Although genetic testing promises a possible future presymptomatic determination and treatment of women who are genetically susceptible to cancer, current data reveal certain dilemmas and uncertainties regarding our ability to interpret the results from testing and offer effective management options. In addition, several complex ethical, legal, and social issues have been revealed with the advent of this new information, which also confirm the need for additional research regarding the most effective use of this genetic information and for the establishment of appropriate clinical management strategies.
Journal of Assisted Reproduction and Genetics, 1996
Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF
Journal of Assisted Reproduction and Genetics, 2000
Human Reproduction Update, 1999
In-vitro fertilization (IVF) and assisted reproductive techniques have become common practice in ... more In-vitro fertilization (IVF) and assisted reproductive techniques have become common practice in many countries today, regulated by established legislation, regulations or by committee-set ethical standards. The rapid evolution and progress of these techniques have revealed certain social issues that have to be addressed. The traditional heterosexual couple, nowadays, is not considered by many as the only 'IVF appropriate patient' since deviations from this pattern (single mother, lesbians) have also gained access to these treatments. Genetic material donation, age limitation, selective embryo reduction, preimplantation genetic diagnosis, surrogacy and cloning are interpreted differently in the various countries, as their definition and application are influenced by social factors, religion and law. Financial and emotional stresses are also often described in infertile couples. Information as deduced from the world literature regarding IVF regulation, as well as about the existing religious, cultural and social behaviours towards these new technologies, is presented in this article in relation to the social aspects of assisted reproduction.
Human Reproduction, 2002
BACKGROUND: The objective of this retrospective study, which included 51 men with non-obstructive... more BACKGROUND: The objective of this retrospective study, which included 51 men with non-obstructive azoospermia, was to evaluate the predictive value of the results of the first sperm recovery attempt on the probability for sperm recovery in a second attempt. METHODS AND RESULTS: A positive testicular fine needle aspiration (TEFNA) was defined as the recovery of any number of mature sperm. At the first and second TEFNA attempts, mature sperm were recovered in 33 (64.7%) and 25 (49%) of 51 patients respectively. In 23 of the 33 (69.7%) patients with a positive first TEFNA, sperm were recovered at both attempts, whereas in only two of 18 (11.1%) with a negative first TEFNA, sperm were recovered at the second attempt. Our analysis revealed a high predictive value of the first TEFNA for sperm recovery at the subsequent attempt, with a mean positive predictive value of 69.7%, with the highest probability being 90.9% in hypospermatogenesis, 72.7% in Sertoli cell-only pattern, 75% in tubular hyalinization, and the lowest being 28.6% in maturation arrest. The mean negative predictive value was 88.9%, which was high in all categories (80% in Sertoli cell-only pattern and 100% in maturation arrest and tubular hyalinization). CONCLUSION: A second TEFNA attempt should be offered to all non-obstructive azoospermic patients with a positive first TEFNA. Patients with a negative first TEFNA may undergo a repeated attempt, but a donor sperm back-up is strongly advised.
Human Reproduction, 2004
BACKGROUND: Elevated maternal serum levels of interleukin-2 soluble receptor-a (IL-2 sRa), tumour... more BACKGROUND: Elevated maternal serum levels of interleukin-2 soluble receptor-a (IL-2 sRa), tumour necrosis factor-a (TNF-a) and interferon-g (IFN-g) have been associated with pregnancy loss. The aim of our study was to evaluate the predictive value of these cytokines in the outcome of early IVF pregnancies. METHODS: One hundred and ®fty-nine consecutive IVF patients who were subsequently diagnosed to have a biochemical pregnancy (n = 23), a ®rst-trimester miscarriage (n = 19) or a normal term delivery (n = 117) were included in this study. Serum was collected from the initial pregnancy test, 11 days after a day 3 embryo transfer, and all samples were analysed for IL-2 sRa, TNF-a and IFN-g by commercially available enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: IL-2 sRa levels were signi®cantly higher in patients with an early pregnancy loss compared with patients with a normal term delivery (849.5 T T 69.6 versus 693.5 T T 31.2 pg/ml, P = 0.02), and a cut-off point of IL-2 sRa >1000 pg/ml predicted a poor pregnancy outcome (44.4 versus 22.7% pregnancy loss, IL-2 sRa b1000 versus IL-2 sRa <1000 pg/ml; P = 0.02). IFN-g-positive patients had twice the risk for poor IVF pregnancy outcome compared with IFN-g-negative subjects (40.8 versus 20.0%, respectively; P < 0.02), including a signi®cantly lower implantation rate (37.6 T T 0.05 versus 50.0 T T 0.03%, respectively; P = 0.02). There was no difference in pregnancy outcome based upon serum levels, or the ability to detect the presence of TNF-a. No differences in levels of these cytokines were found based on the aetiology of the patients' infertility. CONCLUSIONS: Elevated maternal serum levels of IL-2 sRa and IFN-g as early as 11 days after embryo transfer are associated with poor IVF pregnancy outcome.
The Kinetics of Leptin in Meigs' Syndrome
Gynecologic Oncology, 2001
The aim of this study was to assess the kinetics and possible role of leptin in the pathophysiolo... more The aim of this study was to assess the kinetics and possible role of leptin in the pathophysiology of Meigs&#39; syndrome. We report on a 62-year-old patient admitted for a large ovarian tumor, hydrothorax, and ascites. The patient underwent abdominal hysterectomy and bilateral adnexectomy revealing a benign ovarian fibroma and no evidence of malignant cells in the pleural or peritoneal fluids. Analysis of serum, peritoneal, and pleural fluids from this patient was performed before, during, and after the operation. Preoperatively, the patient had low levels of leptin in the serum, peritoneal, and pleural fluids. Serum levels increased after removal of the ovarian tumor along with the resolution of ascites and hydrothorax. Leptin levels inversely correlate to tumor burden, third space fluid accumulation, and clinical status in Meigs&#39; syndrome. These findings suggest the involvement of leptin in the pathophysiology of this syndrome.
Luteal estradiol patch/GnRH-antagonist suppression prior to gonadotropin stimulation improves IVF outcome in poor responders: A novel approach
Fertility and Sterility, 2004
Decreasing the risk of multiple pregnancy in IVF: Lessons learned from embryo cryopreservation
Fertility and Sterility, 2004
Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders
Fertility and Sterility, 2005
The administration of a luteal E2 patch/GnRH antagonist protocol before gonadotropins in poor res... more The administration of a luteal E2 patch/GnRH antagonist protocol before gonadotropins in poor responders may improve ovarian stimulation and result in greater uniformity in follicular development and improved pregnancy rates.
Fertility and Sterility, 2005
Objective: To report a case of spontaneous ovarian hyperstimulation resulting from an FSH-secreti... more Objective: To report a case of spontaneous ovarian hyperstimulation resulting from an FSH-secreting pituitary adenoma. Design: Case report. Setting: University hospital. Patient(s): A 29-year-old previously healthy, nulligravid woman. Intervention(s): Transphenoidal resection of the adenoma. Main Outcome Measure(s): Clinical remission. Result(s): After transphenoidal resection of the adenoma, the patient had an uneventful postoperative recovery with complete resolution of ovarian hyperstimulation and associated symptoms. Postoperative magnetic resonance imaging demonstrated residual tumor within the cavernous sinus. Conclusion(s): Follicle-stimulating hormone-secreting pituitary adenoma may present as acute spontaneous ovarian hyperstimulation. (Fertil Steril 2005;83:208 -10.
Fertility and Sterility, 2005
Objective: To analyze IVF outcomes in patients with a history of one or more elevations in basal ... more Objective: To analyze IVF outcomes in patients with a history of one or more elevations in basal FSH who have a normal basal FSH at the start of their IVF cycle, compared with the general IVF population. Design: Retrospective clinical study. Setting: University hospital. Patient(s): General IVF patient population. Intervention(s): Patients received standard IVF gonadotropin protocols, oocyte retrieval, and embryo transfer. Main Outcome Measure(s): Oocyte yield, fertilization, implantation, clinical pregnancy, and cancellation rate. Result(s): Oocyte yields were lower in patients with a history of elevated basal FSH, for all age groups, and showed an age-dependent decline in all patients. Over the age of 40 years, both implantation and clinical pregnancy rates were lower in these patients, with no significant difference observed in patients under the age of 40 years. No pregnancies were observed in patients with a history of three or more elevated FSH levels, regardless of age.
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Papers by Sozos Fasouliotis